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When medical research is outdated, it’s the patients who pay

Medical research can now be more person-focused than ever, writes Alex Irving, communications director at Patients Campaigning For Cures.

When Thomas Huxley and colleagues went head-to-head with Bishop Wilberforce in the ‘Great Debate’ of 1860, at the British Science Association annual meeting, it was a major nail in the coffin for creationism and triggered widespread public acceptance of Darwin’s theory of evolution.

Since then, the Theory of Evolution has itself evolved, and to such a degree that medical experts are calling for a second Great Debate, to settle an equally vital question for the scientific community – with seismic consequences for patients in need of effective treatments and cures.

Chronic diseases are rising rapidly. For example, cancer cases in the UK are predicted to rise from 2.5 million in 2015 to four million by 2030 – with an annual cost to the UK economy that currently exceeds £15bn. With so much at stake, we at Patients Campaigning For Cures, welcome the call for rigorous scientific Debate, with growing support at Westminster from over a hundred cross-party MPs (representing seven million UK constituents).

What is outdated and failing medical research?

The majority of research funds are still directed towards animal models of human patients – despite animals now shown to be entirely failing as predictive models of human response to drugs and disease.

Current medical understanding explains why we need to stop funding outdated Victorian principles that ignore critical complex species differences, and to redirect valuable finance towards human-based research, which has a proven track record of success.

Current science shows us how to succeed

Thanks to the scientific breakthroughs made in the early 2000s by the Human Genome Project, we now understand that men and women can respond very differently to drugs and disease, as do different ethnic groups. And we know that identical twins do not always suffer from the same diseases, or react in the same way to a drug, because of very small differences in their genetic makeups. All of which is explained by advances in our knowledge of evolutionary biology and genetics.

The genome project advanced our understanding that the process of evolution does not consist solely of adding new genes to make a new species. Together with other similar achievements, the project informed us that individual humans differ from each other for many of the same reasons that species differ from each other. For example, the same gene can be turned off in one individual but turned on (expressed) in another. During development, mice have turned on the gene that allows them to grow a tail, while humans usually have it turned off. Changes like this can lead to new species – or predispose one individual to a disease while another does not suffer from that illness.

The Human Genome Project also explained that differences between a human and a rat, dog, or monkey are much greater than the differences amongst humans. Very small differences in the genetic makeup between species mean that what happens when a monkey is infected with HIV is very different from what happens when humans are infected. This also explains why medicines that are safe and effective in mice kill or maim humans – and vice versa. Humans can share 99 per cent of their genetic makeup with another species and yet still demonstrate profound differences in terms of responses to drugs and disease. With 90 per cent of drugs that looked promising in animals failing at the human clinical trial stage, pharmaceutical companies openly and often acknowledge the very costly lack of predictive value animal models have in their drug development process.

Personalized medicine means matching the correct drug to the patient in order to maximize efficacy while minimizing side effects. There are now over 100 medicines linked to specific genes, and patients can be tested for those genes before being given those drugs. Cancer therapies can be based on a patient’s genome instead of a one-size-fits-all solution. Studies in humans have shown that children with certain genes require more medicine for post-operative pain control. Many diseases are now treated based on such unique genetic information. All of this is in stark contrast to testing on completely different species.

Today there is a rapid growth in innovative human-relevant research models, harnessing a range of contemporary digital and biotechnologies, collectively known as Non-Animal Technologies (NATs). Innovate UK has identified NATs as emerging science that could help drive future UK economic growth, with the global market expected to be worth billions. Redirecting funding towards human-based medical research is a win-win for individual patients and society as a whole.

The first step towards vital medical research reform is to settle the science publicly – and what better way than to hold the sequel to the Huxley-Wilberforce debate? We propose Great Debate Two: between Dr. Ray Greek, the leading expert against animal models of human responses to drugs and disease – who has already agreed to participate – and the neurobiologist and noted proponent of animal-based research, Professor Colin Blakemore.

We therefore welcome this Open Letter to Professor Blakemore, and hope that he will respond positively.

Open letter:

Professor Colin Blakemore, 

 

A freedom of information request provided your letter to the Planning Inspectorate, recommending the extension of a Beagle Breeding Farm at B&K Universal in Grimston Hull. The farm will purpose breed around 2,000 dogs annually, destined for painful and traumatic laboratory experiments - typically involving dogs being force-fed chemicals in experiments lasting 90 days with no pain relief or anaesthetic. According to current medical knowledge the results of such experiments are not capable of predicting the responses of human patients, a position highlighted by The British Medical Journal in its Editor’s Choice, June 2014.

 

Over 100 MPs, to date, have signed Parliamentary EDMs to hear this evidence in a public scientific debate, overseen by independent judges from the relevant fields of scientific expertise. In your letter, you claim to have “always tried to engage with those who oppose animal research and take proper account of their objections”, and that it is “unacceptable” that research “is impeded or prevented by extreme action”. We therefore call upon you to agree to participate in the thorough scientific debate, as called for by the Parliamentary EDMs and their growing support. 

 

Yours sincerely,

 

Ricky Gervais

Chris Packham

Peter Egan 

Dr Jane Goodall DBE

Jane Fallon

Lesley Nicol

Jill Robinson MBE

Rumer

Rick Wakeman

 

This Open Letter will remain active at www.forlifeonearth.org, where further public figures can sign it.

The University Challenge final. Photo: BBC iPlayer
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Why University Challenge is deliberately asking more questions about women

Question setters and contestants on how the show finally began to gender-balance its questions – and whether it’s now harder as a result.

University Challenge has long had a gender problem. When the show first started airing in 1962, some Oxbridge colleges were still refusing to admit women as undergraduates; in the decades since, women have been consistently outnumbered by men, with all-male teams still a regular occurrence. Those women that did appear were all too regularly criticised and objectified in equal measure by audiences: notable contestants like Hannah Rose Woods, Emma Johnson, Samantha Buzzard and Sophie Rudd have experienced intense media scrutiny and criticised the sexism of the show and audiences. In recent years, sexism rows have dogged the show.

How satisfying, then, to see two women carrying their teams in last night’s final: Rosie McKeown for winners St John’s, Cambridge, and Leonie Woodland for runners-up Merton, Oxford. Both secured the majority of points for their teams – McKeown with visible delight, Woodland looking unsure even as she delivered correct answer after correct answer.

But there is another site of sexism on University Challenge, one that earns less column inches: the questions. Drawing on all areas of history, science, language, economics and culture, the questions often concern notable thinkers, artists, scientists, and sportspeople. Of course, our society’s patriarchal hierarchies of achievement have meant that the subjects of these questions are mostly men. General knowledge is, after all, a boys’ club.

Over the course of this 2017-8 series, though, I noticed a shift. More women than ever seemed to be making their way into the questions, at times with deliberate reference to the inherent sexism of their lack of cultural prominence. On 5 February, there was a picture round devoted to female composers, with contestents asked to identify Clara Schumann, Ethel Smyth, Rachel Portman and Bjork from photographs, who, Paxman explained, are all “women that are now listed in the EdExcel A Level music syllabus after the student Jessy McCabe petitioned the exam board in 2015.” Episodes have included bonus rounds on “prominent women” (the writer Lydia Davis, the pilot Lydia Litvyak, and the golfer Lydia Ko), “women born in the 1870s and 80s” (Rosa Luxemburg, Elizabeth Arden and Vanessa Bell), and the female philosophers Mary Midgely, Philippa Foot and Iris Murdoch.

Elsewhere, questions raise a knowing eyebrow at the patriarchal assumptions behind so much of intellectual endeavour. A music round on famous rock bands quoted the music critic Kelefa Sanneh’s definition “rockism”: “the belief that white macho guitar music is superior to all other forms of popular music”. Another, on opera, quoted Catherine Clement’s Opera, Or The Undoing of Women, which explores how traditional opera plots frequently feature “the infinitely repetitive spectacle of a woman who dies”. “Your music bonuses are three such operas,” Paxman said dryly, to audience laughter.

University Challenge’s questions editor Thomas Benson confirms that there has been a deliberate attempt to redress a gender imbalance in the quiz. “About three years ago, a viewer wrote in to point out that a recent edition of the programme had contained very few questions on women,” he explains. “We agreed and decided to do something about it.”

Last night’s final included a picture round on artists with works concerning motherhood (Mary Casatt, Lousie Bourgeois, Leanora Carrington and Frida Kahlo) and a music round on Marin Alsop, the first woman to ever conduct the Last Night of the Proms, as well as sets of bonuses on the American writer Willa Kather and Byzantine historian and princess Anna Komnene.

Former winner Hannah Rose Woods is delighted by the increase in such questions. “I think it’s fantastic!” she tells me. “These things are really important in changing people’s perceptions about women in the past, and the way women’s contributions to science and the arts have often been written out of history. We need to keep challenging the idea of the White Male Canon.”

Last night’s winner Rosie McKeown says that while she didn’t necessarily notice a deliberate attempt to gender balance the questions, she was “very pleased with the quality of those questions that did come up”.

“Although it wasn’t in one of our matches,” she tells me, “I thought the picture round on female composers was especially good for highlighting women’s achievements.”

For all the enthusiasm for these questions, in the studio they’re often met with blank stares. While University Challenge questions are broad and imaginatively posed, there are some reliable revision topics and techniques: from Nobel laureates and the years of their wins to identifying famous paintings and classical music excerpts. McKeown says she has been a religious viewer of the show since she was 11 years old, and admits to watching reruns of the show to prepare. Shift the kinds of answers you might be looking for, and teams may struggle.

“Do we know any female British composers?” Leonie Woodland said weakly, looking at a picture of Ethel Smyth. Trying to come up with a female Muslim Nobel laureate, one contestant desperately suggested Aung San Suu Kyi. Asked to provide a first name linking an American concert pianist with the sister of Lazarus one male contestant still buzzed in with “Daniel”.

“Even if we didn’t always get them right,” McKeown tells me, citing that round on female philosophers, which saw them pass on every question, as an example, “it was great to see so many important female figures represented.”

“I don't think the questions about women necessarily affected our performance, but it’s certainly a very good thing that they were there and I hope that they’ll arouse people’s interest in the women featured and in their achievements.”

Benson believes that it hasn’t had a significant effect on performance. “The great majority of the questions that feature women are no different to any others, in that they sit firmly within the realm of standard academic general knowledge.”

He notes that they often refer to historical and background details, citing sets of bonuses on Canadian novelist Ruth Ozeki and British physicist Hertha Ayrton, which both teams answered correctly in full. “Though Ozeki and Ayrton may not be household names, the questions are definitely answerable and deal with central themes in their work and achievements.”

It’s easy to brush off the significance of a fairly geeky Monday night BBC quiz show, but University Challenge still regularly pulls in three million viewers. In any case, a show like University Challenge has a cultural significance that outweighs its viewing figures. It helps to shape our understanding of which subjects are intellectual or important, which are history’s most notable achievements, and who is worth learning about. To ignore questions of identity is to risk intellectual laziness, relying on tired ideas of canonical figures – or worse, supremacist propaganda, privileging the achievements of white men over all others.

Quite aside from making for less predictable and more enjoyable television, by including questions on the likes of Stevie Smith, Nella Larsen, Gertrude Stein, Myra Hess, Margaret Mead, and Beryl Bainbridge, University Challenge can diversify the mental encyclopaedias of its viewers, be it a tweed-wearing 60-year-old in Leamington Spa or an 11-year-old like Rosie McKeown with her own dreams of one day competing. It has a responsibility to do so.

Anna Leszkiewicz is the New Statesman's deputy culture editor.